Neurosyphilis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The symptoms of tabes dorsalis usually develop secondary to long-term untreated syphilis, and start with symptoms such as lightning pains, impaired sensation and proprioception, and hypesthesias. Common complications of tabes dorsalis include Dementia, stroke, eye disease, Paralysis, and Charcot arthropathy (Charcot joint).
Natural History, Complications, and Prognosis
Natural History
Neurosyphilis is one of the manifestations of syphilis disease.
patients with syphilis has this important findings in natural history:
- Painless chancre appears 3-4 weeks after exposure.
- Chancre typically resolves, after which the patient may develop constitutional symptoms and generalized symmetric rash in 4 to 8 weeks.
- This stage is typically self limited to 4 to 8 weeks without treatment and patient enters into asymptomatic latent phase.
- Approximately 25% of patients develop recurrent symptoms in one year.
- Approximately 35% of patients develop tertiary syphilis, which includes the following complications:
- Cardiovascular involvement after 15-30 years (80-85% of patients) including aortic aneurysm, aortic regurgitation, angina, and heart failure
- Gummatous lesions involving skin, bone and joints, associated with significant morbidity and mortality[1][2][3][4]
- Neurologic infection in 10-15 years (5-10% of patients) including cranial nerve dysfunction, meningitis, stroke, acute or chronic altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities
The symptoms of neurosyphilis usually develop secondary to long-term untreated syphilis, and start with symptoms such as:
- cranial nerve dysfunction symptoms:
- Diplopia
- Lightning pains[5]
- Impaired sensation and proprioception[6]
- Hypesthesias[7].
The symptoms of tabes dorsalis typically occurs 10 to 30 years after primary infection by treponema pallidum.[8]
If left untreated, most patients with tabes dorsalis may progress to develop paralysis, dementia, and blindness.
Complications
Common complications of tabes dorsalis include:[9][10]
- Charcot arthropathy (Charcot joint) of the foot may be seen
- Broad base gate and sensory ataxic gait is usually seen in patients with tabes dorsalis
Prognosis
Prognosis varies by site of involvement and duration of disease:[1][2][3]
- Among patients with neurosyphilis, 90% respond to treatment.
- Gummatous lesions reverse with treatment.
- Mortality rates are high with cardiovascular complications.
- Mortality rate of patients with neurosyphilis is around 20% which is mainly due to related complications.
References
- ↑ 1.0 1.1 Thomas SB, Quinn SC (1991). "The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community". Am J Public Health. 81 (11): 1498–505. PMC 1405662. PMID 1951814.
- ↑ 2.0 2.1 GJESTLAND T (1955). "The Oslo study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material". Acta Derm Venereol Suppl (Stockh). 35 (Suppl 34): 3–368, Annex I-LVI. PMID 13301322.
- ↑ 3.0 3.1 Singh AE, Romanowski B (1999). "Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features". Clin Microbiol Rev. 12 (2): 187–209. PMC 88914. PMID 10194456.
- ↑ French P (2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
- ↑ MAO S, LIU Z (2009). "Neurosyphilis manifesting as lightning pain". Eur J Dermatol. 19 (5): 504–6. doi:10.1684/ejd.2009.0712. PMID 19487174.
- ↑ Vora SK, Lyons RW (2004). "The medical Kipling--syphilis, tabes dorsalis, and Romberg's test". Emerg Infect Dis. 10 (6): 1160–2. doi:10.3201/eid1006.031117. PMC 3323152. PMID 15224672.
- ↑ Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
- ↑ Schöfer H (2004). "[Syphilis. Clinical aspects of Treponema pallidum infection]". Hautarzt. 55 (1): 112–9. doi:10.1007/s00105-003-0608-0. PMID 14749871.
- ↑ Kaynak G, Birsel O, Güven MF, Oğüt T (2013). "An overview of the Charcot foot pathophysiology". Diabet Foot Ankle. 4. doi:10.3402/dfa.v4i0.21117. PMC 3733015. PMID 23919113.
- ↑ Tso MK, Koo K, Tso GY (2008). "Neurosyphilis in a non-HIV patient: more than a psychiatric concern". Mcgill J Med. 11 (2): 160–3. PMC 2582679. PMID 19148316.